CPT 59855 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures for Maternity Care and Delivery |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AG - Primary physician |
| Complexity Level | Moderate |
National average reimbursement for CPT 59855 by major payers:
$527.35
$556.05
$562.30
$687.78
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 59855 | ||||||
United | 59855 | $110.00 | 1851531248 - LASER SURGERY HOLDING COMPANY, LTD | 550882748 - (AZ) LASER SURGERY HOLDING COMPANY LT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1061.00 | 1720407273 - BRONX SC LLC, EMPIRE STATE AMBULATORY SURGERY CENTER | 273045919 - (NY) BRONX SC LLC DBA EMPIRE STATE AMBULATORY SURGERY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1122.00 | 1124438684 - VANCOUVER DENTAL SURGERY CENTER | 910851599 - THE VANCOUVER CLINIC, INC., PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $72.00 | 1043367196 - SURGICAL SPECIALISTS GROUP, LLC, ALABAMA OUTPATIENT SURGERY CENTER | 201398879 - (AL) SURGICAL SPECIALISTS GROUP, LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $445.00 | 1306005343 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $385.00 | 1447599659 - SOUTHEAST EYE SURGERY CENTER, LLC | 455054338 - (TN) SOUTHEAST EYE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $63.00 | 1225286354 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $299.00 | 1003875873 - WILDCREEK SURGERY CENTER | 880377689 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1964.00 | 1003144353 - PIEDMONT WEST AMBULATORY SURGERY CENTER | 264422348 - (GA) PIEDMONT WEST AMBULATORY SURGERY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1501.00 | 1811957251 - AMBULATORY SURGERY CENTER OF CENTRALIA, LLC, SURGERY CENTER OF CENTRALIA | 883961418 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1081.00 | 1639195217 - CY FAIR SURGERY CENTER | 760386971 - (TX) CY FAIR SURGERY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1231.00 | 1134431323 - BETHESDA CHEVY CHASE SURGERY CENTER, LLC | 272875760 - (MD) BETHESDA CHEVY CHASE SURGERY CEN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $2785.00 | 1982667499 - CLEAR LAKE SURGICARE, LTD | 621600411 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $900.00 | 1538167978 - VALLEY SURGICAL CENTER LTD, VALLEY SURGERY CENTER | 300035229 - (OH) VALLEY SURGICAL CENTER LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $743.00 | 1043690845 - UNION HILLS PAIN PARTNERS LLC, HONORHEALTH PAIN MANAGEMENT CENTER | 473325492 - (AZ) UNION HILLS PAIN PARTNERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 59855 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59855 code is part of the Surgery services used for Surgical Procedures for Maternity Care and Delivery. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 59855 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 59855-CPT | Moderate | Induced Abortion, By 1 Or More Vaginal Suppositories (Eg, Prostaglandin) With Or Without Cervical Dilation (Eg, Laminaria), Including Hospital Admission And Visits, Delivery Of Fetus And Secundines; |
| 59856-CPT | Moderate | Induced Abortion, By 1 Or More Vaginal Suppositories (Eg, Prostaglandin) With Or Without Cervical Dilation (Eg, Laminaria), Including Hospital Admission And Visits, Delivery Of Fetus And Secundines; With Dilation And Curettage And/Or Evacuation |
| 59857-CPT | Moderate | Induced Abortion, By 1 Or More Vaginal Suppositories (Eg, Prostaglandin) With Or Without Cervical Dilation (Eg, Laminaria), Including Hospital Admission And Visits, Delivery Of Fetus And Secundines; With Hysterotomy (Failed Medical Evacuation) |
| 59866-CPT | Moderate | Multifetal Pregnancy Reduction(S) (Mpr) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59855. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59855 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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